Flow diagram of the search and selection process.

<p>Flow diagram of the search and selection process.</p

Assessing medical professionalism: A systematic review of instruments and their measurement properties

<div><p>Background</p><p>Over the last three decades, various instruments were developed and employed to assess medical professionalism, but their measurement properties have yet to be fully evaluated. This study aimed to systematically evaluate these instruments’ measurement properties and the methodological quality of their related studies within a universally acceptable standardized framework and then provide corresponding recommendations.</p><p>Methods</p><p>A systematic search of the electronic databases PubMed, Web of Science, and PsycINFO was conducted to collect studies published from 1990–2015. After screening titles, abstracts, and full texts for eligibility, the articles included in this study were classified according to their respective instrument’s usage. A two-phase assessment was conducted: 1) methodological quality was assessed by following the COnsensus-based Standards for the selection of health status Measurement INstruments (COSMIN) checklist; and 2) the quality of measurement properties was assessed according to Terwee’s criteria. Results were integrated using <i>best-evidence synthesis</i> to look for recommendable instruments.</p><p>Results</p><p>After screening 2,959 records, 74 instruments from 80 existing studies were included. The overall methodological quality of these studies was unsatisfactory, with reasons including but not limited to unknown missing data, inadequate sample sizes, and vague hypotheses. <i>Content validity</i>, <i>cross-cultural validity</i>, and <i>criterion validity</i> were either unreported or negative ratings in most studies. Based on <i>best-evidence synthesis</i>, three instruments were recommended: Hisar’s instrument for nursing students, Nurse Practitioners’ Roles and Competencies Scale, and Perceived Faculty Competency Inventory.</p><p>Conclusion</p><p>Although instruments measuring medical professionalism are diverse, only a limited number of studies were methodologically sound. Future studies should give priority to systematically improving the performance of existing instruments and to longitudinal studies.</p></div

Summary of best-evidence synthesis.

<p>Summary of best-evidence synthesis.</p

Methodological quality of each study per measurement property.

<p>Methodological quality of each study per measurement property.</p

Classification of instruments based on Wilkinson and Goldie taxonomy.

<p>Classification of instruments based on Wilkinson and Goldie taxonomy.</p

Rating levels for the quality of a measurement property.

<p>Rating levels for the quality of a measurement property.</p

Terwee’s quality criteria for measurement properties [32].

<p>Terwee’s quality criteria for measurement properties [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0177321#pone.0177321.ref032" target="_blank">32</a>].</p

Summary of the measurement properties of instruments.

<p>Summary of the measurement properties of instruments.</p

Flow diagram of the search and selection process.

<p>Flow diagram of the search and selection process.</p

Moral distress from professionalism dilemmas and its association with self-rated professionalism behaviors among Chinese residents

Residents inevitably witness or participate in a diverse range of professionalism dilemmas. However, few studies have focused on residents’ moral distress from professionalism dilemmas and its relationship with residents’ professionalism. This study aimed to understand the moral distress that Chinese residents may face after exposure to professionalism dilemmas and to examine the associations between moral distress and residents’ perceived fulfillment of professionalism behaviors. We conducted a cross-sectional survey of residents from four standardized residency training bases in Liaoning Province, China, using stratified cluster sampling. A checklist of professionalism dilemmas, the Moral Distress Scale, and the Behavior-based Medical Professionalism Inventory were used to assess residents’ moral distress from professionalism dilemmas and their perceived fulfillment of professionalism behaviors. Descriptive statistics, non-parametric tests, multiple linear regressions, and binary logistic regressions were used to analyze the data. A total of 647 (81.1%) residents effectively completed the survey. The proportion of residents suffering from moral distress ranged from 58.4 to 90.6% for different professionalism dilemmas. As the number of professionalism dilemmas associated with moral distress increased, residents reported lower fulfillment of professionalism behaviors (β p  0.05). Compared with residents with no distress, residents suffering from distress reported lower fulfillment of professionalism behaviors (OR p  0.05). Among residents suffering from distress, as the distress intensity increased, residents reported higher fulfillment of professionalism behaviors (OR > 1, p  0.05). Residents suffered a wide range of moral distress from professionalism dilemmas, and residents with moral distress reported lower fulfillment of professional behaviors. A responsive reporting system for residents and reflection on role modeling may help residents cope with the negative effects of moral distress and professionalism dilemmas.</p